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The Senate Foreign Relations Committee on Thursday voted 18-3 to approve a bill (S 2731) that would reauthorize the President's Emergency Plan for AIDS Relief at $50 billion over five years, CQ Today reports. ...

"Sen. Tom Coburn (R-Okla.) has said in a letter that is circulating among senators that he might block attempts to pass both House and Senate bills (HR 5501, S 2731) that would reauthorize the President's Emergency Plan for AIDS Relief, CQ Today reports. Coburn plans to send the letter, which asks for support from other senators, to Senate Minority Leader Mitch McConnell (R-Ky.).

Coburn in the letter wrote that the PEPFAR reauthorization bills "contain dramatic policy reversals coupled with irresponsible spending levels," adding that the "combination prevents our support for reauthorization of the program that, until now, has been a rare model of foreign aid success." Coburn added that he wants to preserve a requirement in the existing law that 55% of PEPFAR funding be spent on treatment for HIV/AIDS and prevention of mother-to-child transmission."

I wonder if by "dramatic policy reversals" Coburn was referring to the clause Sen. Kerry attached to the bill to lift the HIV travel ban into the US on non-citizens?

I wonder if by "dramatic policy reversals" Coburn was referring to the clause Sen. Kerry attached to the bill to lift the HIV travel ban into the US on non-citizens?

Hi everybody!

I've noticed that there hasn't been much talk on this subject lately, so I thought I'd jump in.

Full disclosure: I'm not HIV-positive. That's right; I'm HIV-. However, my fiancée, whom I love very much, is HIV-positive. She also lives in another country. Therefore, I have become a bit of an expert in HIV immigration matters, and the so-called HIV "travel ban." I also happen to be a lawyer, not that that means anything.

So I don't know if anybody objects to my posting here. If so, I apologize.

I've been studying the PEPFAR reauthorization debate, and the maneuvering by John Kerry and others that succeeded in getting the new language into the version of the PEPFAR bill that was approved by the Senate Foreign Relations Committee. Here's my take on it.

I think Senator Coburn is mostly worried about the absence of any requirement in both the House and the Senate's version of the reauthorization bill requiring any particular level of spending on treatment of people who are HIV-positive. At least this is what he has said in several press releases, and on his website. (He has even made public statements saying that the new PEPFAR bill does nothing to prevent "baby AIDS" -- he means vertical transmission, mother to child -- because the new law doesn't require ARVs for any particular number of pregnant mothers or the newborns.) The second issue for Coburn is the $50 billion price tag, although this is a bit of a fake issue. True, the new PEPFAR law would allow UP TO $50 billion in spending, but this is more of a ceiling than the floor, so to speak. Congress still has to authorize the money on a case-by-case or year-by-year basis. The legislative analyst has already concluded that the most that could be authorized for 2009, for example, would be around $9 billion or so.

Personally, I don’t think Coburn will make much headway with his arguments. Even other Senators who agree with him are careful to point out that they're not opposed to PEPFAR generally, and perhaps not TOO strongly opposed to increasing spending. Remember, the great majority of politicians are in favor of reauthorizing PEPFAR at a $50 billion level. A substantial majority of the House voted this way, the President supports it, and the Senate Foreign Relations Committee vote was very strongly in favor of the $50 billion authorization.

In spite of the foregoing, however, I think the issue "travel ban" issue is far from settled. It MIGHT be repealed, but it might not. The House (full body, not just a committee) has recently voted to approve reauthorizing PEPFAR, but unlike the Senate's version, the language they approved DID NOT include a provision repealing the "travel ban."

In other words, under the House version, the "travel ban" would stay intact, i.e., nothing would change. Under the Senate version the "travel ban" would be thrown out. It remains to be seen which version will prevail, assuming the Senate version is finally approved in its current form.

I actually do not disagree with some of Coburn's points about PEPFAR itself. There are a lot of issues within the PEPFAR bill worth debating about in terms of where the money would go and what strings are attached. But those would probably require another thread altogether.

As to the price tag, while it's quite laudable to commit that amount to fight global HIV pandemic, I do think something needs to be said about the inadequacy of funding to address the same epidemic right here in the US, both in terms of prevention and access to treatment. Again, that would likely need a different thread.

Kerry's maneuvering to include repealing the HIV travel ban in the Senate version of the PEPFAR bill would most likely put this issue on the spotlight and test whether the senators (and congresspeople) are ready to talk openly about this issue or continue to ignore it. The house and senate versions of the original bills intended to repeal the travel ban (H.R. 3337 & S. 2486) have already been introduced last year and are languishing in the committees where they were referred. If this gets dropped from the PEPFAR bill before it goes to the Senate floor for a vote, then we know what that means.